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Dr. Manley : Services : Detail
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| Acne Treatment |
Acne is a medical condition that can result in social concerns and permanent scarring. We take acne patients seriously and utilize a full range of treatments including topical retinoids (such as Retin-A®), topical and oral antibiotics, mechanical extrusion, cortisone injections of cysts,
microdermabrasion, IPL phototherapy, and Accutane®.
Patient Information on Acne Treatment
Acne is a serious medical condition that needs to be treated aggressively to avoid social problems and to minimize or prevent permanent scarring. Patients, parents, and physicians often dismiss acne as a malady not worthy of medical treatment until it is too late. Acne is a serious disease that often requires treatment by a physician.
What is acne? Acne is a disease of pilosebaceous units (hair follicles and their associated sebaceous glands). Sebaceous glands secrete a thick, fatty material called sebum that passes to the skin surface through the pilosebaceous duct. Sebaceous glands are most numerous on the face, upper back, and chest. Sebum production increases in the adolescent years and is high in some adults. Patients with high sebum production have a greater risk of developing acne.
P. acnes is a normal human skin bacterium and the dominant microbe in sebum. If the bacteria overgrows in sebum it causes changes in consistency of the material leading to plugging of the outflow duct. This results in a comedone. If the duct opening is closed the comedone appears white and is referred to as a whitehead. If the duct is open, exposing the sebum to the air, the material turns black and the comedone is called a blackhead.
Frequently, P. acnes also irritates or inflames the lining of the hair follicle. The follicle may become a red and tender bump called a papule. Papules may progress to pustules that have red bases with puss in the center. If the follicle wall ruptures it can form large, painful, solid nodules or puss-filled cysts. Cysts often lead to scaring.
Types of acne. Acne lesions can be divided into two general types: inflammatory and non-inflammatory.
Non-inflammatory. This type of acne is limited to whiteheads and blackheads.
Inflammatory. When P. acnes leads to inflammation of the hair follicles the disease is called inflammatory acne. Inflammatory acne is classified as mild, moderate, or severe based on the number of lesions present. Severe inflammatory acne includes cystic acne.
Mixed. It is not uncommon for a patient to have both types of acne at the same time.
Treatments for acne. Acne is a serious and common problem that causes sufferers to seek all manner of “cures.” The bottom line is that it is a disease that needs to be treated in most cases by a physician. Medical treatments for acne include the following:
Preparation. The skin should be washed gently with Cetaphil or a similar cleanser no more than twice per day (avoid soap products). Before applying medications let the skin dry completely by waiting 20-30 minutes.
Topical retinoids. Retinoids such as Retin-A, Differin, or Tazorac are used in all types of acne and may be the drug of choice for non-inflammatory acne. Retinoic acids thin sebum, prevent comedone formation, and help expel plugs. These medications also enhance the effectiveness of topical antibiotics and benzoyl peroxide. Patients may develop burning, dryness, redness, and peeling in the first few weeks of use. Acne often gets worse in weeks 3-6 before it gets better.
Benzoyl peroxide. Benzoyl peroxide is a drying and antibacterial agent. It is available over the counter and by prescription. It may cause drying and redness. Benzoyl peroxide is also available combined with topical antibiotics.
Acne extrusions and injections. Manually removing the plugs from comedones; cleaning out pustules; and opening and draining cysts can dramatically hasten clearing of acne lesions. Skillfully performed extrusions performed with proper surgical instruments by a qualified nurse or esthetician can dramatically improve cosmetic appearance. Sometimes injections of tiny amounts of the anti-inflammatory medication cortisone into nodules or cysts can help clear these lesions.
Antibiotics. Antibiotics reduce the population of P. acnes bacteria and also may have a direct anti-inflammatory effect within the hair follicle. Common topical antibiotics include erythromycin and clindamycin. Oral antibiotics frequently used in acne treatment include tetracyclines (tetracycline, doxycycline, and minocycline), erythromycin, and clindamycin. Antibiotic resistance is an increasing concern. Strains of P. acnes are developing resistance to treatment with antibiotics. Other infective bacteria may become resistant to antibiotic treatment in other human infections due to constant exposure to antibiotics for acne therapy.
Oral contraceptives. Some oral contraceptives are proven to reduce acne in female patients. Ortho Tri-Cyclen is specifically approved by the FDA for acne therapy. Some antibiotics may reduce the contraceptive effectiveness of oral contraceptives.
Accutane. Accutane is an oral retinoid that is the most effective of all acne treatments. It reduces sebum production, thins sebum, and reduces the population of P. acnes. It generally results in dramatic clearing and long-term remission of acne. Accutane treatment is reserved for severe inflammatory, nodular, or cystic acne; moderate acne unresponsive to conventional treatment; and patients who scar or have excessive oiliness. Accutane causes birth defects and cannot be used in a pregnant patient. Only physicians registered in the SMART program supervised by Roche Laboratories, Inc. are authorized to prescribe Accutane. Dr. Manley is an authorized prescriber.
Links to acne web sites:
http://www.acnesoft.com
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